1407000623 NPI number — BAYOU MEDICAL CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407000623 NPI number — BAYOU MEDICAL CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYOU MEDICAL CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
1ST CALL DME
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407000623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1799 STUMPF BLVD
Provider Second Line Business Mailing Address:
BLDG 7 SUITE 8
Provider Business Mailing Address City Name:
GRETNA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70056-2596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-367-0029
Provider Business Mailing Address Fax Number:
504-367-0014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1799 STUMPF BLVD
Provider Second Line Business Practice Location Address:
BLDG 7 SUITE 8
Provider Business Practice Location Address City Name:
GRETNA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70056-2596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-367-0029
Provider Business Practice Location Address Fax Number:
504-367-0014
Provider Enumeration Date:
11/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
LEW
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
504-367-0029

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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